Medicaid dental services for most adults - except pregnant women, children, the blind and senior disabled - were cut from Missouri's Medicaid program in 2005, when lawmakers eliminated Medicaid coverage for more than 90,000 low-income parents, seniors and disabled, and cut benefits such as dental and eyeglasses from more than 300,000 adults in the state's Medicaid program.

Lawmakers then believed the cuts were needed to balance the budget that increased school funding without seeking higher taxes.

Organizations like the Missouri Dental Association (MDA) and the Missouri Primary Care Association (MPCA) have been advocating for the reinstatement of dental services ever since.

"The primary need is an attempt to divert those adult patients that don't have dental coverage from the ERs (emergency rooms) where they are seeking relief from pain, but not necessarily getting the dental problem solved," said Patrick Baker, legislative and regulatory director for MDA.

He said officials at MDA are thankful the current General Assembly understands the need for good oral health, but state policy is not the only barrier low-income Missourians must overcome to receive dental care.

"Transportation is always a barrier for low-income adults," he said. "Just getting to the appointment."

He also cited language and education as barriers.

"What we have learned from the American Dental Association is that dental utilization is down and was decreasing before the recession, which leads them to believe it won't necessarily rebound as the economy rebounds," Baker said. "There needs to be education to all patients, not just Medicaid patients, that dental health is important and it should be a primary care component, just as they go for an annual physical or checkup with their physician."

"More people now gaining access will probably increase the utilization of (dental) services," he said. "The biggest issue is the shortage and the maldistribution of dental providers."

He said MPCA is working to address the shortage with the University of Missouri-Kansas City School of Dentistry and A.T. Still University's Missouri School of Dentistry & Oral Health, which opened a new dental school in Kirksville last fall.

"We're hoping to increase the supply of dentists," Pierle said. "Our current dental workforce is aging, and I think over half of them are 50 and older. The workforce issue to me is the next most critical issue."

MPCA is part of the Missouri Coalition for Oral Health, and the organization has also built an Oral Health Network comprised of all of the Community Health Centers in the state.

Pierle said another barrier is persuading dentists to accept Medicaid patients because "the reimbursement rate is terribly low."

"But the action the Legislature took not only restored the benefit, but enhanced the reimbursement rate," he said.

Don Holloman, chief executive officer of the Community Health Center of Central Missouri, said he's excited the Legislature had the foresight to put dental benefits for Medicaid back into the budget.

The Community Health Center operates a dental clinic for low-income Missourians and staffs five dentists.

"Dental care has always been a critical need," Holloman said. "In the budget, we're glad the Legislature also sees that critical need."